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Jennifer Sahira Sunukanto

Kualitas Hidup Pasien Kanker Paru pada Pandemi COVID-19 = Quality of Life of Lung Cancer Patients during COVID-19 Pandemic

"Latar belakang: Situasi pandemi COVID-19 membawa dampak terhadap berbagai aspek kehidupan, terutama pada masyarakat dengan penyakit kronis seperti kanker paru. Perubahan akibat pandemi memengaruhi tingkat kualitas hidup pasien yang penting untuk kesejahteraan hidup mereka. Penelitian ini bertujuan untuk memberikan gambaran kualitas hidup pasien kanker paru pada pandemi COVID-19.

Metode: Studi dengan metode potong-lintang dilakukan di Poli Rawat Jalan Onkologi Toraks RSUP Persahabatan, Jakarta. Sampel diambil menggunakan metode consecutive sampling. Tingkat kualitas hidup dinilai menggunakan kuesioner European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (EORTC QLQ-C30) versi Bahasa Indonesia. Penelitian ini juga menilai karakteristik sosiodemografis dan klinis pasien, serta faktor terkait COVID-19 yang meliputi kekhawatiran akan terhambatnya pengobatan, paparan informasi mengenai COVID-19, hambatan akses menuju fasilitas kesehatan, hambatan kelanjutan pengobatan, tekanan mental yang dialami, serta hubungan dengan keluarga dan teman selama pandemi COVID-19.

Hasil: Sebanyak 94% dan 6% pasien kanker paru memiliki tingkat kualitas hidup sedang dan buruk selama pandemi COVID-19. Keseluruhan pasien mengalami gangguan kualitas hidup selama pandemi, tetapi tidak ditemukan adanya hubungan yang bermakna secara statistik pada tingkat kualitas hidup dengan karakteristik subjek, maupun dengan pandemi COVID-19. Sebagian besar pasien mengkhawatirkan keterlambatan pengobatan dan mengalami tekanan psikologis, namun hanya sedikit pasien yang mengalami hambatan pengobatan selama pandemi.

Kesimpulan: Studi ini menunjukkan adanya gangguan kualitas hidup pada pasien kanker paru selama pandemi COVID-19. Diperlukan adanya penelitian lebih lanjut serta pengembangan intervensi yang lebih holistik dan komprehensif untuk pasien kanker paru, terutama selama pengobatan jarak jauh.

Kata kunci: Kanker Paru, Kualitas Hidup, COVID-19

Introduction: The COVID-19 pandemic has affected various aspects of life, especially for people with chronic diseases such as lung cancer. The changes due to the pandemic impact their quality of life (QoL) which is important for their well-being. This study aimed to provide an overview of lung cancer patients’ QoL during the COVID-19 pandemic.
Method: A cross-sectional study was conducted in the Thoracic Oncology Outpatient Clinic of Persahabatan National Respiratory Referral Hospital, Jakarta. Patients were recruited using consecutive sampling methods. QoL was assessed using the Indonesian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (EORTC QLQ-C30). This study also assessed the patients’ sociodemographic and clinical characteristics and the factors related to COVID-19, including concerns about treatment delays, exposure to COVID-19 information, barriers to access to healthcare facilities and treatment continuation, psychological pressure, and interpersonal relationships with family and friends.
Results: 94% and 6% of lung cancer patients have moderate and poor QoL during the COVID-19 pandemic. All patients have impaired QoL, but no statistically significant relationship was found between QoL and the subjects’ characteristics or the factors related to the pandemic. Most patients are concerned about treatment delays and experiencing psychological pressure, but only a few patients experience treatment barriers during the pandemic.
Conclusion: This study showed an impaired QoL in lung cancer patients during the COVID-19 pandemic. Further research and development of more holistic and comprehensive interventions for lung cancer patients, particularly during remote treatment, are needed."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Skripsi Membership Universitas Indonesia Library

Amanda Safira Aji

Perubahan proses terapi pasien kanker paru selama pandemi covid-19 = Changes in lung cancer treatment during the covid-19 pandemic.

"Latar belakang: Pandemi COVID-19 membawa perubahan yang besar terhadap sistem pelayanan kesehatan, salah satunya pada terapi kanker paru. Berbagai keterbatasan yang dihadapi tenaga kesehatan dan risiko COVID-19 yang tinggi pada pasien kanker paru menyebabkan terjadinya perubahan terapi pada pasien kanker paru. Penelitian ini bertujuan untuk mengetahui perubahan terapi dan tingkat kekhawatiran pada pasien kanker paru.

Metode: Penelitian potong lintang yang melibatkan pasien rawat jalan kanker paru dilakukan di Poli Onkologi RSUP Persahabatan. Pemilihan sampel dilakukan menggunakan metode consecutive sampling. Perubahan terapi pasien kanker paru selama pandemi dinilai menggunakan survei daring yang disusun oleh Dutch Federation of Cancer Patients Organisations dan Dutch Multidisiplinary Oncology Foundation yang dimodifikasi dan diterjemahkan dalam Bahasa Indonesia. Karakteristik subjek yang meliputi karakteristik demografi, karakteristik kanker paru, jenis terapi, dan riwayat infeksi COVID-19 turut dinilai dalam penelitian ini.

Hasil: Sebanyak 68,2% pasien kanker paru mengalami perubahan terapi selama pandemi COVID-19. Tidak ditemukan adanya korelasi antara karakteristik dan tingkat kekhawatiran subjek dengan perubahan terapi selama pandemi COVID-19. Kekhawatiran terhadap perubahan terapi ditemukan pada 77,3% subjek penelitian.

Kesimpulan: Penelitian ini menemukan tingginya proporsi pasien kanker paru yang mengalami perubahan selama pandemi COVID-19. Perubahan terapi selama pandemi sebaiknya mempertimbangkan dampak psikologis pasien dan efektivitas terapi. Diperlukan penelitian lebih lanjut untuk mengetahui faktor-faktor yang memengaruhi perubahan terapi selama pandemi COVID-19.

Introduction: The COVID-19 pandemic has brought major changes to the health care system, one of which is lung cancer treatment. Various limitations faced by health workers and the high risk of COVID-19 in lung cancer patients led to changes in lung cancer treatment. This study aims to assess changes in therapy and level of concern in lung cancer patients.
Method: A cross-sectional study involving lung cancer outpatients was conducted in Thoracic Oncology Outpatient Clinic in Persahabatan National Respiratory Referral Hospital Jakarta, Indonesia. Sample recruitment was done using consecutive sampling method. Changes in therapy for lung cancer patients during the pandemic were assessed using an online survey by the Dutch Federation of Cancer Patients Organizations and the Dutch Multidisciplinary Oncology Foundation which was modified and translated into Bahasa. Patients characteristics, including demographic characteristics, lung cancer characteristics, type of therapy, and history of COVID-19 infection were also assessed in this study.
Result: A total of 68.2% of lung cancer patients reported changes in therapy during the COVID-19 pandemic and 77,3% were concerned about treatment changes. No correlation was found between the characteristics and level of concern of the subjects with changes in treatment during the COVID-19 pandemic.
Conclusion: This study found a high proportion of lung cancer patients who experienced changes during the COVID-19 pandemic. Changes in therapy during a pandemic should take into account the psychological impact of the patient and the effectiveness of therapy. Further research is needed to determine the factors that influence the changes during the COVID-19 pandemic."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Skripsi Membership Universitas Indonesia Library

Wiendo Syah Putra Yahya

Profil efikasi dan toksisitas terapi target baru golongan Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor (EGFR-TKi) pada pasien kanker paru karsinoma bukan sel kecil non skuamosa dengan mutasi EGFR positif dibandingkan dengan kemoradioterapi pada EGFR Wild type = Profile of efficacy and toxicity the new targeted therapy of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKi) in non small cell lung cancer non squamous with mutated EGFR compared with chemoradiotherapy in wild type

"Latar belakang : Terapi target baru golongan EGFR-TKi telah direkomendasikan sebagai terapi lini pertama untuk pasien KPKBSK non skuamosa dengan mutasi EGFR positif. Belum tersedia data di Indonesia tentang efikasi dan toksisitas terapi target baru EGFR-TKi pada pasien KPKBSK dengan mutasi EGFR positif dibandingkan dengan kemoradioterapi pada EGFR wild type di RSUP Persahabatan Jakarta.

Metode : Disain penelitian ini kohort retrospektif melalui resume medis pasien KPKBSK non skuamosa di RSUP Persahabatan periode Januari 2010 sampai Juli 2014. Teknik pengambilan sampel adalah consequtive sampling. Jumlah sampel 61 pasien yang terdiri dari 31 pasien KPKBSK non skuamosa dengan mutasi EGFR positif yang diberikan terapi target baru EGFR-TKi dan 30 pasien dengan EGFR wild type yang diberikan kemoradioterapi.

Hasil : Karakteristik pasien KPKBSK non skuamosa dengan mutasi EGFR yang positif adalah laki-laki sebanding dengan perempuan, bukan perokok, mutasi delesi di ekson 19 sebanding dengan mutasi L858R di ekson 21, angka tahan hidup 1 tahun 48,37%, rata-rata time to progression 284 hari sedangkan pasien EGFR wild type adalah laki-laki lebih dominan, perokok, angka tahan hidup 1 tahun 33,3% dan rata-rata time to progression 210 hari dan overall survival 293 hari. Uji T independen menunjukan terdapat hubungan yang bermakna antara terapi target baru EGFR-TKi dengan lama time to progression (p=0,028). Toksisitas yang sering ditemukan pada terapi target baru EGFR-TKi adalah mual- muntah (6,8%) diare (16,2%), alopesia (3,2%) dan kelainan kulit kemerahan (12,9%) sedangkan pada kelompok kemoradioterapi toksisitas yang ditemukan adalah anemia (13,3%), leukopenia (6,7%) dan trombositopenia (3,3%).

Kesimpulan : Pasien KPKBSK non skuamosa dengan mutasi EGFR yang positif dan diberikan terapi target baru EGFR-TKi memiliki time to progression yang lebih lama dan toksisitas yang dapat ditoleransi.

Background: The new targeted therapy of EGFR-TKi has been recommended as first-line therapy for patients with NSCLCC non-squamous with mutated EGFR. There are no data about the efficacy and toxicity of the new targeted therapy of EGFR-TKi in NSCLC non-squamous with mutated EGFR compared with chemotradiotherapy in wild type at Persahabatan Hospital, Jakarta.
Methods: The design of study are retrospective cohort through medical records of NSCLC non-squamous patients in the Department of Pulmonology and Respiratory Persahabatan Hospital in January 2010 to July 2014. The sampling technique is consequtive sampling. The number of samples are 61 patients consisted of 31 patients with NSCLC non-squamous with mutated EGFR treated the new targeted therapy of EGFR-TKi and 30 patients with EGFR wild type treated chemoradiotherapy.
Results: The characteristics of NSCLC non-squamous patients with positive mutated EGFR are male compared to women, non-smokers, a deletion mutation in exon 19 L858R mutation comparable with in exon 21, 1-year survival 41,9%, mean time to progression is 284 days and patients of wild-type mutation are more dominant in males, smokers, 1-year survival 33,3% and mean time to progression is 210 days and overall survival is 293 days . The independent t test showed a significant relationship between the new targeted therapy with EGFR-TKi and TTP (p = 0.028). The most common adverse events in the EGFR-TKi group are nausea and vomitus 96,8%), diarrhea (16,2%), alopecia (3,2%) and rash (12,9%) and in the chemotherapy group, anemia (13,3%), leucopenia (6,7%) and thrombocytopenia (3,3%).
Conclusions: The EFGR-TKi for patients with advanced non small cell lung cancer who are selected on the basis of EGFR mutations improve time to progression with acceptable toxicity."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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UI - Tugas Akhir Universitas Indonesia Library

Fadhlia Majidiah

Proporsi pasien kanker paru yang mengalami trombosis vena dalam berdasar kriteria klinis Wells di Rumah Sakit Persahabatan = Deep vein trombosis proportion among lung cancer patiets using Wells score in Persahabatan Hospital Jakarta

"Latar belakang: Trombosis vena dalam merupakan komplikasi tersering yang dijumpai pada keganasan. Insidens trombosis vena dalam pada kanker paru sangatlah tinggi bila dibandingkan dengan populasi umum. Saat ini belum ada pedoman alur diagnosis yang dapat menegakkan diagnosis trombosis vena dalam pada kanker paru. Selain itu, penelitian serupa juga belum pernah dilakukan di Indonesia sehingga hasil penelitian ini dapat menjadi penelitian pendahuluan yang menitikberatkan pada trombosis vena dalam pada kanker paru.

Tujuan: Tujuan penelitian ini adalah untuk menilai proporsi trombosis vena dalam menggunakan kriteria klinis yaitu skor Wells’ pada pasien kanker paru yang dirawat di RS Persahabatan.

Metode: Desan penelitian ini menggunakan metode potong lintang. Kami melakukan pemeriksaan pada pasien kanker paru yang dirawat sejak September 2012 hingga Februari 2013. Kami menyingkirkan pasien kanker paru dengan penyakit infeksi serta pasien kanker paru dengan sediaan histopatologi yang belum tegak. Pemeriksaan fungsi hemostasis seperti PT, APTT dan D-dimer tetap dilakukan bersama dengan penggunaan kriteria klnis skor Wells’. Diagnosis trombosis vena dalam ditentukan apabila skor Wells berat.

Hasil: Subjek dalam penelitian ini terbanyak adalah laki-laki (69,2%) dengan kelompok usia terbanyak yaitu kelompok usia 51-60 tahun (33,3%). Jenis histopatologi yang terbamyak ditemukan adalah jenis adenokarsinoma (57,7%). Hampir sebagian besar pasien yaitu 64 pasien (82,1%) memiliki D-dimer >500 dan hanya 14 pasien (17,9%) dengan D-dimer normal. Penelitian ini mengungkapkan proporsi trombosis vena dalam menggunakan skor Wells adalah 23,1%.%. Faktor-faktor seperti jenis kelamin, usia, riwayat merokok, jenis tumor, stadium tumor, status penampilan, serta fungsi hemostasis tidak berpengaruh terhadap trombosis vena dalam namun nilai D-dimer >500 berpengaruh terhadap trombosis vena dalam.

Kesimpulan: Proporsi trombosis vena dalam pada pasien kanker paru di RS Persahabatan hampir sama jumlahnya dengan penelitian-penelitian di negara lain yaitu sekitar 21%. Penelitian ini menunjukkan bahwa skor Wells masih mempunyai peran penting dalam menentukan trombosis vena dalam mengingat penggunaannya mudah dan praktis. Penelitian selanjutnya diperlukan untuk menilai metode yang mudah dan sederhana digunakan dalam praktek sehari-hari bersama dengan skor Wells dalam menentukan trombosis vena dalam pada kanker paru.

Background: Deep vein trombosis (DVT) is the common complication found in malignancy. Its incidence in lung cancer is much higher than in general population. Since there were no current diagnosis guideline which could help identify DVT in lung cancer and there were no similar study conducted before in Indonesia, thus this study could be a pilot study for further research focusing DVT in lung cancer.
Objective: The objective of this study is to find deep vein trombosis proportion among lung cancer patients which is determined by clinical criteria such as Wells’ score in Persahabatan Hospital.
Method: The study design is using a cross-sectional method. We examined the lung cancer patients who were hospitalized within September 2012 to Februari 2013. We excluded the lung cancer patients with infection comorbidity or who had not yet had histopathological confirmation. The hemostatis work up included PT, APTT, and D-dimer were conducted along with clinical Wells’ score criteria. Deep vein trombosis among the patients is determined by severe Wells’ score.
Results: Subjects in this study were mostly male (69,2%) with predominant age group of 51-60 years old (33,3%). Predominant histopathologic sub type was adenocarcinoma (57,7%). Mostly, 64 patients (82,1%) had D-dimer >500 and only 14 patients (17,9%) with normal D-dimer. This study found that deep vein trombosis proportion is 23,1% using Wells’ score. Clinical characteristics such as sex, age, smoking history, tumor cell type, tumor staging, performance status and hemostasis function does not have correlation with DVT but score of D-dimer >500 have correlation with DVT.
Conclusion: The DVT proportion among lung cancer patients in Persahabatan Hospital is similar found in some studies in other countries which is approximately 21%. This study revealed that the simple and practical application of Wells’ score in determining DVT is still have valueable role. Further study is needed to find the best simple and easy methods along with Wells’ score in determining DVT in daily practice."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013

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UI - Tesis Membership Universitas Indonesia Library

Herman Suryatama

Kadar kotinin urin dan CO ekspirasi pada perempuan dewasa yang terapajan asap rokok di lingkungan rumah = Urinary cotinine concentrations and CO expiration in women exposed to environmental tobacco smoke at home

"[ABSTRAK

Latar Belakang: Penelitian mengenai dampak kesehatan dari pajanan asap rokok lingkungan dengan menggunakan kotinin, yaitu suatu hasil metabolisme nikotin yang terdeteksi dalam urin, telah direkomendasikan sebagai pengukuran kuantitatif nikotin dalam tubuh dan biomarker pajanan asap rokok lingkungan. Tujuan: Tujuan penelitian ini untuk melihat hubungan pajanan asap rokok di rumah pada perempuan dewasa bukan perokok, dengan mengukur kadar kotinin urin, CO ekspirasi dan melihat dampak kesehatannya.

Metode: Penelitian ini berjenis potong lintang terhadap 60 orang perempuan dewasa bukan perokok terpajan dan 58 orang tidak terpajan asap rokok di rumahnya dalam wilayah Pasar Rebo, Jakarta. Kadar kotinin urin diukur menggunakan metode pemeriksaan ELISA. Sebagai informasi tambahan, kami mengumpulkan data kadar CO ekspirasi, kuesioner kebiasaan merokok anggota keluarga di rumah dan dampak kesehatan respirasi subyek penelitian.

Hasil: Nilai median kadar kotinin urin yang didapat adalah 24,65 ng/ml pada kelompok terpajan dan 7,30 ng/ml pada kelompok tidak terpajan (p=0.000). Nilai median kadar CO ekspirasi adalah 5,00 ppm pada kelompok terpajan dan 3,00 ppm pada kelompok tidak terpajan (p=0.000). Durasi terpajan asap rokok (jumlah jam/hari) pada perempuan perokok pasif memiliki hubungan signifikan dengan tinggi rendahnya kadar kotinin urin(p=0.037). Gejala sesak napas yang muncul berhubungan signifikan dengan status pajanan asap rokok subjek (p=0.01). Faktor lama pajanan asap rokok terakhir memiliki hubungan signifikan dengan kadar CO ekspirasi (p=0,004). Nilai titik potong kotinin urin antara kelompok terpajan dan tidak terpajan asap rokok adalah 14,4 ng/ml (sensitifitas 75,0 %, spesifisitas 74,0 %, p=0.000). Nilai titik potong CO ekspirasi adalah 3,5 ppm (sensitifitas 75,0 %, spesifisitas 81,0 %, p=0.000).Terdapat korelasi yang cukup kuat dan signifikan antara kadar CO ekspirasi dan kotinin urin (r=0,641, p=0,000).

Kesimpulan: Kadar kotinin urin dan CO ekspirasi pada perempuan dewasa yang terpajan asap rokok lebih tinggi dibandingkan perempuan yang tidak terpajan asap rokok di rumah. Pengukuran kotinin urin adalah metode pengukuran pajanan asap rokok lingkungan dalam tubuh yang sensitif, non-invasif dan efektif.;Introduction :Studies of environmental tobacco smoke (ETS) health effects using cotinine, a nicotine metabolite detected in urine, has been recommended as a quantitative measurement of nicotine intake and as biomarker for ETS exposure in humans.

ABSTRACT

Objective: The aim of this study is to correlate dailyindoor ETS exposure in non-smokers (adult women) by measuring urinary cotinine levels, CO expiration and it`s health effects.

Method: We performed a cross-sectional study to 60 ETS-exposed and 58 non ETS exposed adult women in Pasar Rebo area, Jakarta. The urinary cotinine concentrations were measured and analyzed using ELISA method. In addition, CO expiration data and other information were collected through questionnaire regarding smoking habits of the subjects family members at home and respiratory health effects occured to subjects.

Results: Significant median urinary cotinine concentrations were found; 24,65 ng/ml in ETS-exposed group and 7,30 ng/ml in non-exposed to ETS group(p=0,000). Significant median CO expirationalso were found; 5,00 ppm in ETS exposed group and 3,00 ppm in non-exposed to ETS group (p=0.000). Total ammount of time (hours/day) women exposed to ETS in their house was significantly correlated to urinary cotinine concentrations result (p=0,037). The respiratory symptoms (dyspnea) occured to subjects showed significant relation with ETS exposure status (p=0,01). Time duration of last exposed to ETS had significant relation with CO expiration (p=0.004).The urinary cotinine concentrations cut-off point to differentiate ETS exposed and non-ETS exposed group in adult women was 14,4 ng/ml (sensitivity 75%,specificity 74%,p=0.000). The CO expiration cut-off point was 3,5 ppm (sensitivity 75%, specificity 81%, p=0.000). Strong and significant correlation was found between CO expiration and urinary cotinine value (r=0,641, p=0,000).

Conclusion: The urinary cotinine concentration and CO expiration are significantly higher in women exposed to tobacco smoke at home group than the non-exposed group. Urinary cotinine measurement is a sensitive, noninvasive and effective method to correlate with ETS exposure.;Introduction :Studies of environmental tobacco smoke (ETS) health effects using cotinine, a nicotine metabolite detected in urine, has been recommended as a quantitative measurement of nicotine intake and as biomarker for ETS exposure in humans.

Objective:The aim of this study is to correlate dailyindoor ETS exposure in non-smokers (adult women) by measuring urinary cotinine levels, CO expiration and it`s health effects.

Method :We performed a cross-sectional study to 60 ETS-exposed and 58 non ETS exposed adult women in Pasar Rebo area, Jakarta. The urinary cotinine concentrations were measured and analyzed using ELISA method. In addition, CO expiration data and other information were collected through questionnaire regarding smoking habits of the subjects family members at home and respiratory health effects occured to subjects.

Results :. Significant median urinary cotinine concentrations were found; 24,65 ng/ml in ETS-exposed group and 7,30 ng/ml in non-exposed to ETS group(p=0,000). Significant median CO expirationalso were found; 5,00 ppm in ETS exposed group and 3,00 ppm in non-exposed to ETS group (p=0.000). Total ammount of time (hours/day) women exposed to ETS in their house was significantly correlated to urinary cotinine concentrations result (p=0,037). The respiratory symptoms (dyspnea) occured to subjects showed significant relation with ETS exposure status (p=0,01). Time duration of last exposed to ETS had significant relation with CO expiration (p=0.004).The urinary cotinine concentrations cut-off point to differentiate ETS exposed and non-ETS exposed group in adult women was 14,4 ng/ml (sensitivity 75%,specificity 74%,p=0.000). The CO expiration cut-off point was 3,5 ppm (sensitivity 75%, specificity 81%, p=0.000). Strong and significant correlation was found between CO expiration and urinary cotinine value (r=0,641, p=0,000)

Conclusion :The urinary cotinine concentration and CO expiration are significantly higher in women exposed to tobacco smoke at home group than the non-exposed group. Urinary cotinine measurement is a sensitive, noninvasive and effective method to correlate with ETS exposure., Introduction :Studies of environmental tobacco smoke (ETS) health effects using cotinine, a nicotine metabolite detected in urine, has been recommended as a quantitative measurement of nicotine intake and as biomarker for ETS exposure in humans.

Objective:The aim of this study is to correlate dailyindoor ETS exposure in non-smokers (adult women) by measuring urinary cotinine levels, CO expiration and it`s health effects.

Method :We performed a cross-sectional study to 60 ETS-exposed and 58 non ETS exposed adult women in Pasar Rebo area, Jakarta. The urinary cotinine concentrations were measured and analyzed using ELISA method. In addition, CO expiration data and other information were collected through questionnaire regarding smoking habits of the subjects family members at home and respiratory health effects occured to subjects.

Fakultas Kedokteran Universitas Indonesia, 2015

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UI - Tugas Akhir Universitas Indonesia Library

Kasum Supriadi

Angka tahan hidup pasien kanker paru kelompok bukan sel kecil non skuamosa yang mendapat terapi target Epidermal Growth Factor Receptor-Tyrosin Kinase Inhibitor dan yang mendapat kemoterapi lini pertama di Rumah Sakit Persahabatan = The survival rate of non squamous by non small cell lung carcinoma patiens who are given by target therapy Epidermal Growth Facttor Receptor-Tyrosin Kinase Inhibitors and those given by first line kemotheraphy treatment at Persahabatan Hospital

"[ABSTRAK

Pendahuluan. Kanker paru jenis karsinoma bukan sel kecil (KPKBSK) terdiri dari nonskuamosa dan skuamosa. Kanker paru jenis karsinoma bukan sel kecil nonskuamosa adalah adenokarsinoma dan karsinoma sel besar. Saat ini terapi kanker paru sangat berkembang dari agen kemoterapi sampai terapi target terutama EGFR-TKI. Penelitian ini bertujuan untuk menilai angka tahan hidup pasien KPKSBK nonskuamosa yang mendapat kemoterapi lini pertama dibandingkan terapi EGFR-TKI di RSUP Persahabatan.

Metode. Penelitian ini adalah penelitian retrospektif antara tahun 2010 sampai 2013 dari rekam medis pasien KPKBSK non skumosa yang mendapatkan kemoterapi lini pertama dan EGFR-TKI. Pasien dikemoterapi dengan platinum baseddan EGFR-TKI diterapi gefitinib 1x250 mg/hari atau erlotinib 1x150 mg/hari. Angka tahan hidup dinilai dari mulai tegak diagnosis sampai pasien meninggal atau saat penelitian dihentikan.

Hasil. Dari 96 sampel KPKBSK non skuamosa terdiri dari 48 pasien yang mendapat kemoterapi lini pertama dan 48 pasien yang diterapi EGFR-TKI. Berdasarkan karakteristik pasien, usia terbanyak adalah 40-60 tahun (kemoterapi 32 (66,7%) dan EGFR-TKI 31 (64,6%) dengan jenis kelamin laki-laki yang mendominasi (kemoterapi 25(52,1%), EGFR-TKI 27 (56,2%). Pasien merokok yang mendapat kemoterapi lini pertama 41,7% dan EGFR-TKI 56,3% dengan IB terbanyak untuk kemoterapi (IB ringan 27,1%) dan untuk EGFR-TKI (IB sedang 22,9%). Jenis histologi adenokarsinoma 95,8% dengan dominasi stage IV 89,6% (kemoterapi 91,7% dan EGFR-TKI 87,5%) disertai tampilan status 2 59,4%. Angka tahan hidup pasien (ATH) 6 bulan 74%, ATH 1 tahun 22,90% dan ATH 2 tahun 6,20%. Masa tengah tahan hidup (MTTH) pasien yang mendapat EGFR-TKI lebih lama sedikit dibandingkan yang mendapat kemoterapi lini pertama (263 hari versus 260 hari.

Kesimpulan. Masa tahan hidup 1 tahun pasien KPKBSK non skuamosa yang diterapi EGFR-TKI sedikit lebih lama dibandingkan kemoterapi lini pertama (263 hari vs 260 hari). Sedangkan ATH 1 tahun pasien kemoterapi lini pertama lebih besar dibandingkan EGFR-TKI (25% vs 20,8%). Faktor yang paling mempengaruhi angka tahan hidup adalah stage dengan nilai p<0,05.

ABSTRACT

Introduction. Lung cancer is the type of non-small cell carcinoma (NSCLC) consists of non-squamous and squamous. Non-small cell lung cancer of non squamous types consist of adenocarcinoma and large cell carcinoma. Currently, lung cancer therapy is highly developed of chemotherapeutic agents to targeted therapy especially EGFR-TKI. This study aims to assess the survival rate of NSCLC patients of non-squamous type who receive first line chemotherapy and those who recieve EGFR-TKI therapy at Persahabatan hospital.

Methods. This study is a retrospective study between 2010 to 2013 from the medical records of NSCLC patients of non-squmous type who receive first-line chemotherapy and thise who recieve EGFR-TKI.Patients with platinum-based chemotherapy and EGFR-TKI with gefitinib therapy 1x250 mg/day or erlotinib 1x150mg/day. Survival rate assessed from start to erect the diagnosis until the patient dies or when the study is discontinued.

Result. From 96 subject of NSCLC patients with non-squamous type consisted of 48 patients who receive first-line chemotherapy, and 48 patients are treate with EGFR-TKI. Based on the characteristics of the patients, most are 40-60 years old (chemotherapy 32 (66.7%) and EGFR-TKI 31 (64.6%) with the male gender that dominates (chemotherapy 25 (52.1%), EGFR-TKI 27 (56.2%). Smoking patients who received first-line chemotherapy are 41.7% and 56.3% of EGFR-TKIs with chemotherapy highest IB (mild IB 27.1%) and for EGFR-TKI (moderate IB are 22.9%). 95.8% of adenocarcinoma histology type with a predominance of stage IV 89.6% (91.7% for chemotherapy and EGFR-TKI 87.5%) with performance status 2 59.4% . Survival rate of patients are 74% for 6 months survival, 1 year survival rate is 22.90% and 2 years survival rate of 6.20%. Median period of survival rate in patients who receiving EGFR-TKI longer than they received first-line chemotherapy (263 days versus 260 days).

Conclusion. Median survival rate of non-squamous NSCLC that treated by EGFR-TKI is longer than first-line chemotherapy (263 days vs 260 days). Although 1 year survival rate first-line chemotherapy in patients is greater than EGFR-TKI (25% vs 20.8%). The factors that most influence the survival rate is stages with p value<0.05.;Introduction. Lung cancer is the type of non-small cell carcinoma (NSCLC) consists of non-squamous and squamous. Non-small cell lung cancer of non squamous types consist of adenocarcinoma and large cell carcinoma. Currently, lung cancer therapy is highly developed of chemotherapeutic agents to targeted therapy especially EGFR-TKI. This study aims to assess the survival rate of NSCLC patients of non-squamous type who receive first line chemotherapy and those who recieve EGFR-TKI therapy at Persahabatan hospital.

Conclusion. Median survival rate of non-squamous NSCLC that treated by EGFR-TKI is longer than first-line chemotherapy (263 days vs 260 days). Although 1 year survival rate first-line chemotherapy in patients is greater than EGFR-TKI (25% vs 20.8%). The factors that most influence the survival rate is stages with p value<0.05., Introduction. Lung cancer is the type of non-small cell carcinoma (NSCLC) consists of non-squamous and squamous. Non-small cell lung cancer of non squamous types consist of adenocarcinoma and large cell carcinoma. Currently, lung cancer therapy is highly developed of chemotherapeutic agents to targeted therapy especially EGFR-TKI. This study aims to assess the survival rate of NSCLC patients of non-squamous type who receive first line chemotherapy and those who recieve EGFR-TKI therapy at Persahabatan hospital.

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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UI - Tesis Membership Universitas Indonesia Library

Garinda Alma Duta

Perbandingan profil adenosin deaminase dan analisis cairan pleura dalam mendiagnosis kepositifan penyakit tuberkulosis dan nontuberkulosis pada pasien dengan efusi pleura di RSUP Persahabatan = The Profile comparasion of adenosin deaminase and pleural fluid analysist in the diagnosis of tuberculosis TB and non TB on subjects with pleural effusion at Persahabatan hospital

"Latar belakang: Efusi pleura tuberkulosis (TB) adalah bentuk umum dari TB ekstra paru. Proporsi efusi pleura pada kasus TB adalah terbesar kedua setelah keganasan di RSUP Persahabatan. Diagnosis definitif ditegakan dengan menemukan basil Mycobacterium tuberculosis (M.tb) dari cairan pleura mapun jaringan pleura walaupun kurang sensitif. Analisis cairan pleura dan pemeriksaan kadar adenosine deaminase (ADA) dapat membantu dalam mendiagnosis efusi pleura pada kasus TB terutama pada negara dengan insidens TB menengah hingga tinggi.

Tujuan: Tujuan penelitian ini adalah membandingkan profil efusi pleura pada kelompok TB dan non-TB.

Metode: Penelitian potong lintang dilakukan terhadap 411 catatan medis subjek dengan efusi pleura yang menjalani prosedur diagnostik di RSUP Persahabatan dari bulan Januari 2013 hingga 31 December 2015 secara retrospektif. Semua jaringan dan cairan diperiksa untuk pemeriksaan mikrobiologi, histopatologi, analisis cairan pleura dan ADA. Total 273 subjek dieksklusikan dan 138 subjek memenuhi kriteria inklusi untuk TB (n=65) dan non-TB (n=73).

Hasil: Nilai tengah usia pada kelompok TB adalah 27 (15-69) tahun dengan proporsi 34 (75%) laki-laki berbeda bermakna dengan nilai tengah usia pada kelompok non TB yaitu 51 (16-75) tahun yang terdiri atas 38 (52%) perempuan. Pada kelompok TB rentang nilai ADA adalah 5,9 hingga 437,6 U/L dengan nilai tengah 103 U/L sedangkan pada kelompok non TB rentang 3,4 hingga 155 U/L dengan nilai tengah 19,9 U/L. Protein cairan pleura pada kelompok TB memiliki rerata 5,6 (SD 1,1) mg/dL berbeda bermakna dibandingkan pada rerata kelompok non TB yaitu 4,9 (SD 1,6) mg/dL. Sensitivitas ADA dengan titik potong 60 IU/dL adalah 89% dengan spesifitas 77% untuk kepositifan TB. Protein cairan pleura dengan titik potong 5 g/dL memberikan sensitivitas dan spesifitas sebesar 60% dan 52%. Pada penelitian ini kombinasi titik potong ADA dengan kadar 60 IU/L dan protein dengan kadar 5 g/dL meningkatkan spesifisitas menjadi 78% dan sensitivitas menjadi 66%.

Kesimpulan: Hasil ADA dan protein cairan pleura harus diintepretasikan bersama temuan klinis dan hasil uji konfirmasi lain.

Background: Pleural effusion is a common form of extra pulmonary tuberculosis (TB). Effusion due to pleural TB is second biggest proportion after malignancy in Persahabatan Hospital. The definitive diagnosis was established by determining the basil of Mycobacterium tuberculosis (M.tb) in the pleural fluid or pleural tissue but less sensitive. Pleural fluid analysis and adenosine deaminase (ADA) level can aid in the diagnosis of TB pleural effusions commonly used in the countries with a moderate to high incidence of TB.
Objectives: The aim of the study is comparing the profile of pleural effusion in TB and non-TB group.
Methods: This is retrospective cross sectional study on 411 subjects with pleural effusions who underwent diagnostic procedure at Persahabatan Hospital by January 1st 2013 to December 31th 2015. All data from tissue and fluid sample of microbiological, histopathological, pleural fluid and ADA examinations were taken from medical records. Total 138 patients met our inclusion criteria for TB (n=65) and non-TB (n=73) and 273 patients were excluded.
Results: Median of age in tuberculosis group age median was 27 (15-69) years old and consisted of 34 male (75%). Median of age in non-TB group was 51 (16.75) years old and consisted of 38 female (52%). In TB groups ADA range from 5.9 to 437.6 U/L with median ADA level 103 and in non TB groups ADA level range from 3.4 to 155 U/L with median 19.9 U/L. In TB groups protein level mean 5.6 (SD 1.1) mg/dL non TB 4.9 (SD 1.6) mg/dL. By using cut off the sensitivity of ADA level 60 IU/dL were 89% with specifity 77%. Protein level cutoff at 5 g/dL the sensitivity and specifity were 60% and 52%. This study showed a combination of ADA and protein as a cut off increasing specifity up to 78% and sensitivity 66%.
Conclusion: The results of ADA and protein of pleural fluid should be interpreted in parallel with clinical findings and the results of comfirmation tests."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

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UI - Tugas Akhir Universitas Indonesia Library

Sophika Umaya

Korelasi antara asupan protein dengan massa bebas lemak dan kapasitas fungsional pasien kanker paru (kajian khusus massa otot dan karnofsky performance status) = Correlation of protein intake, fat-free mass and functional capacity in lung cancer patients

"Homeostasis protein berperan penting dalam memperlambat proses malnutrisi dan dalam mempertahankan massa bebas lemak pasien kanker. Kehilangan signifikan massa bebas lemak terutama massa otot skelet akan mengurangi mobilitas fisik, kapasitas fungsional, dan skor kualitas hidup pasien kanker. Penelitian ini merupakan studi potong lintang yang bertujuan untuk mengetahui korelasi antara asupan protein dengan massa bebas lemak dan kapasitas fungsional pada pasien kanker paru di poli onkologi RS Persahabatan Jakarta. Didapatkan 52 subjek laki-laki dengan rerata usia 55,63 6,77 tahun. Jenis dan stadium kanker yang terbanyak ditemukan adalah adenokarsinoma 63,5, stadium IV 65,4. Status nutrisi kurang berdasarkan IMT ditemui pada 21,2 subjek, dan berdasarkan kadar albumin serum didapatkan 30,8 subjek dengan hipoalbuminemia. Lebih dari 50 subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Pada pemeriksaan komposisi tubuh didapatkan rerata massa bebas lemak 47,20 6,28 kg, dengan 48,1 indeks massa bebas lemak rendah, massa otot rerata 44,74 5,98 kg dengan 40,4 massa otot tergolong kurang. Nilai kapasitas fungsional skala Karnofsky.

The homeostasis of protein plays an important role in decreasing the process of malnutrition and in maintaining fat free mass in cancer patients. The significant loss of fat free mass, especially skeletal muscle mass could decrease physical activity, functional capacity, and quality of life of cancer patients. This was a cross sectional study aimed to investigate the correlation of protein intake, fat free mass and functional capacity in lung cancer patients in the Oncology Unit of Persahabatan Hospital Jakarta. Obtained 52 male subjects with a mean age of 55,63 6,77 years old. The most cancers type were adenocarcinoma 63,5 and most of subjects were at stage IV 65,4 . Nutritional status of the subjects 21,2 were in undernutrition based on body mass index parameter, and 30,8 of the subjects were in hypoalbuminemia. More than 50 of the subjects had low energy and protein intake. The mean of fat free mass was at 47,20 6,28 kg, that 48,1 of fat free mass index were in low categorized, and 40,4 of muscle mass were also in small categorized, that the mean was at 44,74 5,98 kg. Functional capacity Karnofsky scale of the subjects 26,9 showed less than 70. The data showed that the subjects had nutrition problems. This study showed positive and significant correlations between protein intake with fat free mass index r 0,379, p "

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017

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UI - Tesis Membership Universitas Indonesia Library

Putu Ayu Diah P S

Efikasi dan toksisiti kemoterapi karboplatin-vinorelbin pada pasien kanker paru jenis karsinoma bukan sel kecil (KPKBSK) stage lanjut di RSUP Persahabatan = Efficacy and toxicity of carboplatin vinorelbine chemotherapy in advanced non small cell lung cancer (NSCLC) patients at Persahabatan Hospital

"ABSTRAK

Latar Belakang : Paduan kemoterapi berbasis platinum dengan generasi ketiga khususnya karboplatin-vinorelbin sudah sering digunakan sebagai kemoterapi paliatif pada pasien KPKBSK stage lanjut di Indonesia khususnya Rumah Sakit Umum Pusat RSUP Persahabatan namun sampai saat ini belum terdapat data mengenai efikasi dan toksisiti paduan kemoterapi ini di RSUP Persahabatan.Metode : Desain penelitian ini adalah survey observasional retrospektif pada pasien KPKBSK stage lanjut IIIB dan IV yang menjalani kemoterapi lini I di RSUP Persahabatan dengan paduan kemoterapi karboplatin-vinorelbin sejak 1 Januari 2015 sampai 30 Maret 2017.Hasil : Total subjek dalam penelitian ini adalah 38 pasien yang mendapatkan paduan kemoterapi Karboplatin AUC-5 pada hari ke-1 dan vinorelbin 30 mg/m2 pada hari ke1 dan ke-8. Paduan kemoterapi karboplatin-vinorelbin mempunyai efikasi yang baik dengan Objective overall response rate ORR 12,5 dan clinical benefit rate CBR 87,5 . Overall survival OS pada penelitian ini adalah 34,2 dengan masa tengah tahan hidup 387 hari 12,9 bulan dan progression free survival 323 hari 10,7 bulan. Toksisiti hematologi dan nonhematologi yang paling sering terjadi adalah anemia derajat 1 38,4 dan keluhan mual, muntah derajat 2 57,9 . Pada penelitian ini terdapat 2 kasus perdarahan saluran cerna derajat 2 namun pasien masih dapat melanjutkan kemoterapi. Kami juga mendapatkan komplikasi tindakan kemoterapi berupa phlebitis ringan pada 24 pasien 65,7 dan phlebitis sedang pada 1pasien 2,6 .Kesimpulan: Paduan karboplatin-vinorelbin sebagai kemoterapi lini I memiliki efikasi yang baik serta efek toksisiti yang masih dapat ditoleransi sehingga aman diberikan pada pasien KPKBSK stage lanjut. Kata kunci: efikasi, toksisiti, hematologi, nonhematologi, objective overall response rate, clinical benefit rate, overall survival, MTTH, TTP, PFS

ABSTRAK

Background Combination of platinum base and third generation drugs Carboplatin and vinorelbine chemotherapy are frequently used as paliative chemotherapy for Non small cell lung cancer NSCLC patients in Indonesia especially in Persahabatan Hospital. But there are still no data about the activity and tolerability of this regiment in Persahabatan Hospital. This study is conducted to evaluate the efficacy and toxicity of this regiment as first line chemotherapy for advanced NSCLC patients in Persahabatan Hospital.Method This study is an observational survey retrospective study for advanced NSCLC patientswho receive carboplatin vinorelbine regiment as fisrt line chemotherapy since 1st January 2015 to 30th March 2017.Result We observea total of 38 patients who receive carboplatin 5 AUC on day 1 and vinorelbine 30mg m2 on day 1 and 8. This regiment has a good efficacy with overall response rate ORR 12,5 and clinical benefit rate CBR 87,5 . The overall survival OS is 34,2 with median of survival time 387 days 12,9 moths and PFS 323 days 10,7 moths . We found grade 1 anemia 38,4 and grade 2 nausea vomiting 57,9 as hematological and non hematological toxicity that frequently occur in this study. We found 2 cases of grade 2 gastrointestinal bleeding but the patients are still able to continue the chemotherapy after doing some correction for the haemoglobin Hb . We also found mild phlebitis in 24 patients 65,7 and 1 moderate phlebitis in 1 patient 2,6 as procedural complication of this chemotherapyConclusion Combination ofcarboplatin and vinorelbine as first line chemotherapy has a good efficacy and tolerability for advanced NSCLC patients. Key word efficacy, toxicity, haematological, non hematological, overall objective response rate ORR , clinical benefit rate CBR , overall survival OS , median time of survival, time to progression TTP and progression free survival PFS ."

2017

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UI - Tugas Akhir Universitas Indonesia Library

Syarifuddin

Kadar KL-6 serum pada pekerja semen di pabrik semen PT X, Indonesia = Serum KL-6 levels in cement workers at the PT X cement factory, Indonesia

"Latar Belakang : Pneumokoniosis terjadi hampir diseluruh dunia dan merupakan masalah yang mengancam para pekerja semen. Beberapa kelainan serologis dapat ditemukan pada pasien pnemokoniosis. Kadar KL-6 serum meningkat pada pekerja yang terpajan silika sehingga dapat dijadikan penanda hayati untuk diagnosis awal penyakit paru kerja tetapi penelitian ini belum pernah dilakukan di Indonesia

Metode : Penelitian ini merupakan penelitian cross sectional dengan cara pemilihan sampel secara consecutive sampling pada bulan april – mei 2018. Jumlah total subjek sebanyak 77 subjek terdiri dari 60 subjek penelitian dan 17 subjek kontrol. Pemeriksaan kadar KL-6 serum menggunakan metode ELISA. Subjek penelitian merupakan pekerja semen pada area produksi dan bahan mentah.

Hasil : Pada penelitian ini didapatkan hasil dengan karakteristik total subjek laki-laki 100% dan rerata umur 42,5 tahun, subjek termuda 21 tahun dan subjek tertua 55 tahun. Riwayat merokok ditemukan terbanyak bukan perokok 38 subjek (63,3%), diikuti perokok sebanyak 15 subjek (25%), dan bekas perokok sebanyak 7 subjek (11,6%).Tingkat pendidikan sedang 47 subjek (78,3) pendidikan tinggi sebanyak 7 subjek (11,6%) dan pendidikan rendah sebanyak 6 subjek (10%). Lama pajanan < 10 tahun sebanyak 13 subjek (21,6%) dan lama pajanan> 10 tahun sebanyak 47 subjek (78,3%). Penggunaan alat pelindung diri kategori terbanyak kategori sedang sebanyak 50 subjek (83,3%), kategori baik sebanyak 7 subjek (11,6%) dan kategori buruk sebanyak 3 subjek (5%). Rerata kadar KL-6 serum pada kelompok subjek penelitian atau kelompok terpajan sebesar 473,13 U /ml dan rerata kadar KL-6 serum pada kelompok kontrol sebesar 344,13 U/ml.Perbedaan kadar KL-6 serum pada kelompok terpajan dan kelompok control tidak berbeda bermakna secara statistic dengan nilai p = 0,329.

Kesimpulan : Perbedaan antara kadar KL-6 serum kelompok terpajan disbanding kelompok kontrol tidak berbeda bermakna secara statisti

Background : Pneumoconiosis occurs almost all over the world and is a problem that threatens cement workers. Some serological abnormalities can be found in pneumonia patients. Serum KL-6 levels increase in workers exposed to silica so that it can be used as a biological marker for early diagnosis of occupational lung disease but this study has never been done in Indonesia
Method: This study was a cross-sectional study by consecutive sampling in April-May 2018. The total number of subjects was 77 subjects consisting of 60 research subjects and 17 control subjects. Examination of serum KL-6 levels using the ELISA method. Research subjects were cement workers in the production area and raw materials.
Results: In this study, the results were obtained with the characteristics of the total male subjects 100% and the average age of 42.5 years, the youngest subject was 21 years old and the oldest subject was 55 years old. History of smoking was found in the majority of nonsmokers 38 subjects (63.3%), followed by smokers as many as 15 subjects (25%), and former smokers as many as 7 subjects (11.6%). Education level was 47 subjects (78.3) higher education as many as 7 subjects (11.6%) and low education as many as 6 subjects (10%). The duration of exposure <10 years was 13 subjects (21.6%) and the duration of exposure> 10 years was 47 subjects (78.3%). The use of personal protective equipment is the most moderate category as many as 50 subjects (83.3%), the good category is 7 subjects (11.6%) and the bad category is 3 subjects (5%). The mean serum KL-6 level in the research subject group or the exposed group was 473.13 U / ml and the average serum KL-6 level in the control group was 344.13 U / ml. The difference in serum KL-6 level in the exposed group and the control group no statistically significant difference with a value of p = 0.329.
Conclusion: The difference between serum KL-6 levels in the exposed group compared to the control group was not statistically significant"

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019

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