HEMOGLOBIN LEVEL RELATIONS WITH TUMOR RESPONSE IN PATIENTS RECEIVING THE CERVICAL CANCER RADIATION THERAPY IN DR. Sardjito

ABSTRACT: Background: Cervical cancer is the second most common cancer in women worldwide. Radiation therapy is one of the recommended therapies for cervical cancer. But its side effects can suppress bone marrow which decreases hemoglobin (Hb) levels. Hemoglobin is a protein in red blood cells that carry oxygen. During radiation therapy, tumor response depends on tissue oxygenation. Objective: To know the association between hemoglobin levels with tumor response after radiation therapy in patients with cervical cancer. Material and Methods: This study was conducted between May 2012 and February 2013 in 30 patients with cervical cancer during radiation therapy. Hemoglobin level and tumor response were taken from medical record retrospectively. Measurement of Hb levels and tumor response was performed 6 times per week for 5 weeks. Tumor response was measured from the length of tumor. This study used RECIST (Response Evaluation Criteria In Solid Tumors) to evaluate tumor response. Result: During the 5 weeks of therapy, the lowest nadir Hb level was occurred in the second week and the lowest mean Hb level was occurred in the third week. Sixty percent patients had complete response. Partial response was experienced by 40% patient. Mean hemoglobin levels (< 10.5 g/dL) associated with worsening tumor response in patients underwent radiation therapy for 5 weeks (p = 0.045). Conclusion: There was a significant association between the mean hemoglobin levels with tumor response. In this study, the low mean Hb level during radiation therapy could cause a worsening of tumor response. So, the physicians should maintain Hb level above 10.5 g/dL by iron supplementation, blood transfusion, or recombinant human erythropoietin.

RELATIONSHIP BETWEEN SOCIAL SUPPORT TO THE QUALITY OF LIFE IN CANCER PATIENTS DR. Sarjito YOGYAKARTA

ABSTRACT: Background: Cancer is a rapidly developed disease which contributes in major death around the world. In general, cancer patients have an exaggerated response. As a result, they do resentment against themselves and others. Thus, social supports are needed to improve their quality of life Objective: The aim of this research is to discover the correlation between social support and quality of lifeof the cancer patients.This research aims to know the different degrees of social support and quality of life of cancer patients. Methods:Non experimental descriptive analysis using cross-sectional method was applied in the research conducted in DR. Sardjito Hospital Yogyakarta. There are 32 respondents (n=32) who have received a quality of life’s questionnaire developed by European Organization for Research and Treatment of Cancer Quality of Life Close to 30 (EORTC QLQ C-30) and a social support’s questionnaire developed by Multidimensional Scale of Perceived Social Support (MSPSS). Nonparametrik test spaerman with value data α< 0.05 and 95% confidence interval value was used in the research data analysis. Result: This study shows that there is no correlation between social support and the quality of life of the cancer patients. There is no low level of social supports. Moreover, high social supports value is found in 5 patients and medium social supports is found in 27 patients. The median is 36 and min-max is 31-46. The social supports with general health status of the domain have value p=0,525 (p < 0.05). There is no difference between the level of social supports and quality of life of cancer patients. Social supports with diarrhoea symptoms have significant value p=0,029 ( p 0.05 ). Conclusion: In conclusion, there is no correlation between the social supports and the quality of life of cancer patients. Furthermore, there is no difference between the level the of social supports and the quality of life of cancer patients.

RELATIONSHIP BETWEEN THE BULK salivary stimulation WITHOUT USING THE ASSESSMENT OF THE SEVERITY Xerostomia Xerostomia Questionnaire (Study in Patients Radiotherapy in Head and Neck Cancer Dr. Sardjito Hospital)

ABSTRACT: Head and neck radiotherapy may cause xerostomia. Xerostomia may be caused by acinar cells of salivary glands damaged, leads to decrease of saliva quality and quantity. The severity of xerostomia is observed using objective and subjective examinations. Objective examination assessed by unstimulated salivary flow rate measurement. Subjective examination assessed using xerostomia questionnaires. There are two questionnaires used in assessment of xerostomia after head and neck cancer radiotherapy namely Xerostomia Questionnaire (XQ) and Groningen Radiotherapy-Induced Xerostomia Questionnaire (GRIX). The objective of this study is to know the correlation between unstimulated salivary flow rate and severity of xerostomia assessment using these questionnaires. This study used cross sectional observational method. There were 30 head and neck cancer patients undergoing radiotherapy at Radiology Installation of RSUP Dr. Sardjito Yogyakarta in Januari-April 2013 involved in this study. The assessment of xerostomia used xerostomia questionnaires (XQ and GRIX). Unstimulated salivary flow rate was measured for 15 minutes then the result converted into ml/minutes. Data was analyzed using Spearman Rank Correlation. Result of this study was there is a negative significant correlation between unstimulated salivary flow rate and severity of xerostomia assessment using XQ and GRIX with correlation coeficient of -0,452 (p<0,05) and -0,511 (p<0,05). It can be concluded that there is a correlation between unstimulated salivary flow rate and severity of xerostomia assessment using XQ and GRIX for head and neck cancer patients undergoing radiotherapy at RSUP Dr. Sardjito Yogyakarta. The lower the unstimulated salivary flow rate, the more severe xerostomia complained by patients.

RISK FACTORS AFFECTING THE EVENTS IN THE PERIPHERAL INTRAVENOUS CHEMOTHERAPY extravasation Hospital Dr. Sardjito YEAR 2011-2013

ABSTRACT: Background: extravasation is a condition of drug or fluid leakage from vein into surrounding healthy tissue during chemotherapy regimens. Vesicants groups of chemotherapy drugs can cause tissue necrosis. The incidence of extravasation in chemotherapy regimens reported to be 1% to 7%. Risk factors assessed were the following types of drugs, cannula location, age, gender, hypertension, diabetes, number of medications, chemotherapy wards and frequency of chemotherapy as risk factors affecting extravasation event of peripheral intravenous chemotherapy. Extravasation is suspected when there is one or more signs and symptoms include the following patient complained of a burning, stinging, or pain at the puncture site, swollen, blistered at the puncture site, redness around the area of the stabbing, there is no blood flow back and change the quality of the drip . Objective: to determine the incidence of extravasation and risk factors that affect the extravasation of peripheral intravenous chemotherapy. Methods: The design of this study was nested case control study in which patients who received intravenous chemotherapy peripheral selected as cases and controls without extravasation then compared with existing risk factors. Results: event of chemotherapy extravasation as much as 12.7%. Multivariate analysis showed that the risk factors affecting the incidence of peripheral intravenous chemotherapy extravasation is the location of chemotherapy and chemotherapy wards. Power of risk factors on the incidence of chemotherapy extravasation from the smallest to the largest is the location of chemotherapy (p <0,000, OR = 2,365, 95% CI 1,55-3,63), and chemotherapy wards (p <0,000, OR = 3,948, CI 95% 2,12 -7,35). Conclusion: risk factors affecting event of peripheral intravenous chemotherapy extravasation are the location of chemotherapy and chemotherapy wards.

EVALUATION OF DRUG USE OF CHEMOTHERAPY PATIENTS IN THE INSTALLATION OF CERVICAL CANCER HOSPITAL Hospital Dr Moewardi PERIOD JULY - SEPTEMBER IN 2012

ABSTRACT: Cervical cancer is one of leading causes of death related cancer of women worldwide. Purpose of this study was to evaluate chemotherapy drugs in patients with cervical cancer in inpatient RSUD Dr. Moewardi in the period July - September 2012 in terms of the right drug, the right indication, the right patient and the right dose. This study uses descriptive non-experimental research design. Retrieval of data performed retrospectively to patient medical records in 52 cervical cancer patients in the inpatient RSUD Dr. Moewardi the period July to September 2012 that getting chemotherapy. Types of standards that are used are National Comprehensive Cancer Network Clinical Practice Guideline in Oncology (NCCN) version 1.2011 and Protocol use of chemotherapy at the RSUD Dr. Moewardi. The results mentioned cervical cancer patients in inpatient RSUD Dr. Moewardi 57.7% is the patient referral. Age distribution of patients found 59.6% of patients were in the age range of 50 - 64 years. Cycle variation 27.5% of patients undergoing chemotherapy cycle 1. Variations premedication used was Ondansetron. The average length of a maximum of 8 ± 3.2 days. Chemotherapy regimens most widely used drug combination is 86.60% Cisplatin and 5-FU. Appropriateness of indications for drugs 100%, 100% accuracy of the drug, patients 100% accuracy, and precision dose of 92.14% ± 15.7%.
EVALUATION OF COMPLIANCE AND RESPONSE OF NAUSEA VOMITING antiemetic USE THE BREAST CANCER PATIENTS UNDERGOING CHEMOTHERAPY IN Hospital PROF. DR. MARGONO Soekarjo

ABSTRACT: Breast cancer is one of the cancers with the highest incidence, especially in women. The development of therapy has been implemented to improve the survival and prognosis of breast cancer patients. Breast cancer treatment is given by considering many factors, including age, menopausal status, comorbidities, stage of cancer, biological factors and history of chemotherapy. Optimization of quality of life during treatment is very important. Chemotherapy Induced Nausea vomitting (CINV) is a common side effect and can affect the quality of life of cancer patients. The aims of this study are to know response of nausea vomitting, patients adherence, relationship between adherence and response of nausea vomitting. This study is an observational study conducted by descriptive and analytic study design in Prof. Dr. Margono Soekarjo hospital. The results of this study are the nausea and vomitting response are the most in the acute emesis phase (80%) and delayed emesis (90%). A total of 79% adherent and 21% poor adherent. There is no relationship between adherence and the response of nausea vomitting in Prof. Dr. Margono Soekarjo hospital.

Expression of P-glycoprotein, NUCLEAR FACTOR KAPPA B AND PROPORTION OF CANCER STEM CELLS ALDH1-POSITIVE as predictors KEMORESISTENSI

ABSTRACT: Introduction Locally advanced breast cancer is still a health problem, either in developed or developing countries. The role of neoadjuvant chemotherapy has been well known, but there was still nonoptimal response due to chemoresistance mechanism. Range of mechanisms involved in chemoresistance included overexpression of ATP binding cassette (ABC) transporter, apoptosis dysregulation, and possibly the excessive number of cancer stem cells. Chemoresistance process might involve more than one mechanism mentioned. Objective This study aimed to reveal the effect of P-glycoprotein, NF-κB, and ALDH1 expression simultaneously towards pathological response after administration of neoadjuvant chemotherapy FAC regiment, towards recurrence and survival, as well as if it correlates with other predictive/ prognostic factors. Material and methods This was a kohort study. Advanced local stage invasive ductal breast cancer patients were administered with neoadjuvant chemotherapy regiment FAC (Fluorouracil 500 mg/m2-Doxorubicin 50 mg/m2-Cyclophosphamide 500 mg/m2 on the first day of each three-week cycle) in 2008-2011. From incisional biopsy paraffin blocks, the histological grade, nuclear grade, lymphovascular invasion, expression of estrogen, progesterone, HER-2/neu, and KI-67 receptors were examined. Then further immunohistochemical examination for P-glycoprotein, NF-κB, and cancer stem cells ALDH1-positive intratumoral expressions were conducted. From mastectomy paraffin blocks, the pathologic response was also examined. Furthermore, they were followed until the outcome emerged, that is the recurrence and mortality rate until December 2012. Research description was presented in tables and graphics. Chi square method was used for bivariate analysis, and Kaplan-Meier (log rank test) method was used for survival analysis with a significance level of p <0.05. Binary Logistic Regression was used for multivariat analysis for pathological response, whereas for the recurrence and survival outcome, Proportional Hazards (Cox) Regression was used. Results It was suggested that from 131 locally advanced invasive ductal breast carcinoma patients, mainly in the premenopausal age / <50 years (55%), mostly came with primary status cT4 (55%), and the lymph nodes status cN1 (56.5%). Molecular subtypes of triple-negative was the most widely found (38.2%). After neoadjuvant chemotherapy regiment FAC, 87% of patients achieved clinical partial response (cPR) and whilst 88.5% achieved objective response (complete and partial response). Pathological complete response was achieved in 14.5% and major pathological response in 28.2 %. Only as much as 40.5% patients received adjuvant radiotherapy, and 43.5% received hormonal therapy. The most common recurrence location was local recurrence (25.9%), followed by lung (24.2%), and contralateral (13.8%). Variables significantly associated with pathological response was the expression of NF-κB (p = 0.02), while PGP and ALDH1 expression also have effect but it was insignificant (p = 0.15 and p = 0, 17). Other variables that significantly influence pathological response after neoadjuvant chemotherapy was lymphovascular invasion (p = 0.047) and Ki67 expression (p = 0,03). From the multivariate analysis, it was found that strong predictive factors of poor pathological response (no response and minor response) is positive Ki67 expression (RR 2.12; 95% CI 0.99 to 4.55), and premenopausal age (RR 1.87; 95% CI 0.87 to 3.99). The positive expression of PGP given RR = 1.67 (95% CI 0.75 to 3.72); expression of NF-κB positive given RR = 1.74 (95% CI 0.77 to 3.94), and positive ALDH1 expression given RR = 1.76 (95% CI 0.65 to 4.77). Variables significantly associated with the time of recurrence were NF-κB expression (p = 0.02), whereas ALDH1 expression took effect but it was insignificant (p = 0,19). PGP expression did not give effect to the time of recurrence (p = 0,86). Other variables that significantly influence the time of recurrence was lymphovascular invasion (p = 0,06), whereas histologic grade took effect but it was insignificant (p = 0,07). From the multivariate analysis, it was found that a strong predictor factor for recurrence was the expression of positive NF-κB (RR 2.00; 95% CI 0.95 to 4.12). Positive ALDH1 expression gives RR = 1.24 (95% CI 0.68 to 2.28). Variables significantly associated with survival were NF-κB expression (p = 0.04), whereas ALDH1 expression also had effect but it was insignificant (p = 0,25). PGP expression did not affect the time of recurrence (p = 0,84). Other variables that significantly affected the survival time was the lymphovascular invasion (p = 0.006), adjuvant hormonal therapy (p = 0.02), and recurrence (0.001). From the multivariate analysis, it was found that a strong predictor factor for the occurrence of death was recurrence (RR 2.77; 95% CI 1.24 – 6.18) and a positive lymphovascular invasion (RR 2.87; 95% CI 0.84 to 9.84). Whilet he expression of positive NF-κB given RR = 1.27 (95% CI 0.45 to 3.64). Variables significantly associated with PGP, NF-κB, and ALDH1 expression were age, lymphovascular invasion, molecular subtypes, and HER2 expression. Conclusion Expression of NF-κB significantly influenced pathological response, recurrence, and survival. Whereas ALDH1 expression offered no significant influence. Pgp expression apparently only affected pathological response although not significant. There was correlation between the expression of P-glycoprotein (PGP), Nuclear factor kappa B (NF-κB), and ALDH1 with age at diagnosed, lymphovascular invasion, molecular subtypes, and HER2 expression.